Literature of Ayurveda – Brihatrayi – Sushruta Samhita and Astanga Hridaya
Sushruta belongs to Dhanvantari school of thought and is believed to be the Father of Surgery in Ayurveda. Kashiraj Divodas, who is believed to be the second incarnation of Lord Dhanvantari, laid the foundation of Sushruta Samhita. Later in 2nd Century BC, Sushruta reshaped it in a proper text form. Nagarjuna in 5th century and candraöa in 10th century revised the compilation, which is the existing form of Sushruta Samhita available nowadays.
Sushruta 2nd Century BC
Nagarjuna 5th Century AD
candraöa 10th Century AD
Original Sushruta Samhita comprises of 120 chapters. First few sections are similar to Charaka Samhita, but the last section is called as uttaratantra (Appendix). In addition to the main subject of surgery, uttaratantra includes description about the topics on ENT disorders, paediatrics and medicine. The original text is in prose form while the last section is in poetic form which suggests that uttaratantra is an addendum to the original text. The meaning of the word uttaratantra (last section) also reveals the same.
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Sutra Sthana –
Sutra sthana includes 46 chapters which deal with surgery.
- First chapter explains the evolution of surgical training, aims and objectives of Ayurveda and the importance of surgical branch
- Second chapter consists of an index and references to the most important subjects
- The other chapters cover basic principles of surgery, important surgical instruments, different methods of cauterization, application of leeches, wounds and various subjects of internal medicine- like seasonal regimen, pathyapathya (Diet regimen), Nine kriyakala i.e. Pathogenesis, disease classification, prognosis, various therapies and some principles like rasa, virya and vipaka are also discussed.
Nidana Sthana –
It includes 16 chapters which explain the aetiology of mainly surgical diseases like haemorrhoids, urinary calculus, fistula-in-ano, diabetes, ascites, abscess, breast abscess, fractures and hernia.
Sharir Sthana –
Sushruta Samhita is said to be the best in Sharir sthana, which consists of 10 chapters. This includes human anatomy, embryology and marma-vijnyana (knowledge of vital points which is the essential for surgeons)
Chikitsa Sthana –
This section includes 40 chapters which comprise the treatment of the diseases mentioned in nidana sthana. This section also includes important topics like rasayana, vajikaran and panchakarma.
This section has 8 chapters. They elaborate various recipes for the evacuation procedures compiled under panchakarma and also deal with toxicology.
It contains 66 chapters which cover topics like ENT, paediatrics, internal medicine, preventive medicine and psychiatry.
Salient features of Sushruta Samhita
- Procedure of human body dissection by maceration method was first ever described in Ayurveda by Sushruta. The sage author also emphasized that the physician or surgeon should not be authorized to treat any patient unless he has gained knowledge of human body by performing dissection under the guidance of his guru
- Knowledge of anatomy which includes count and description of bones, joints, nerves is praiseworthy. Anatomy and physiology of heart, blood and circulation, layers of skin are also described in depth
- Its classification of fractures, wounds, abscesses and burns, as well as the elaboration of procedures, have all stood the test of time. These include simple surgical procedures like dressing, bandaging as well as more complex procedures like cataract operation, anorectal surgery and plastic surgery
- Sushruta is believed to be the first plastic surgeon, since he performed operation for cleft lip, cleft palate and rhinoplasty. The same methods are being used till date. Thus Sushruta can be considered as father of surgery
- A unique concept of pathogenesis is described by Sage Sushruta This concept is about tracking the pathogenesis of disease as six successive stages of gradual manifestation or progression of disease. These stages if identified by the physician are six vital opportunities for him to start early measures for prevention and treatment of the disease and also to timely arrest its worsening
- Beautiful description of arrangement of the hospital and the ideal behavior of the patient guides us regarding the establishment of various wards in the modern hospitals of today’s era
- A portrayal of an ideal operation theater can also be found in Sushruta Samhita
- Description of about 100 varieties of blunt instruments and 20 types of sharp instruments is found in Sushruta Samhita. Various types of sutures are also mentioned. Concept of sterilization was also known during that period and instruments were sterilized by boiling in water. Fumigation is also mentioned in order to avoid post operative wound infections.
- Excellent sixty different methods for wound and ulcer treatment are mentioned.
- Management of emergency cases like burns, drowning, hanging and strangulation has been explained. Sushruta has extensively dealt with abdominal sections, setting of fracture and dislocations, removal of haemorrhoids and amputation of limbs.
- Classification of plants according to their action. Single drug therapy like Haridra ie. Turmeric (Curcuma longa) for diabetes, tuvaraka (Ceaesalpinia paniculata) for skin disease was introduced.
Commentaries on Sushruta samhita
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Vagbhata Samhita (Astanga Sangraha & Astanga Hridaya)
This is comparatively recent treatise from the Brihatrayi.
Vagbhata (seventh century AD) was the author of the text hence the name. This treatise is believed to be a summary of Charak and Sushruta with selected additions from other Ayurvedic writers like Agnivesha, Bhela and Harita to make the text up to date. He introduced a number of new herbs and made valuable modification and additions.
Contents – It has six sections containing 120 chapters.
Vagbhata had written the text with the verses in a beautiful poetry form which enables the student to memorize important subject in a concise form in an easier manner.
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Salient features of Astanga Hridaya
- Concise and poetic presentation
- Beautiful well-edited compilation of the best concepts from Charak and Sushruta
- Pharmacology is very well elaborated. Concept of vipaka e. post digestive effect of edible substances is very well defined
- Many plants are mentioned for their specific action on a particular disease for e.g. guduchi (Tinospora cordifolia) for vatarakta (gout); musta (Cyperus rotundus) for jvara (fever).
- Newer formulations were introduced in many diseases for e.g. Surana Putapaka for haemorrhoids;, Mandur Vataka for anaemia, etc.
- Instant oleation formulae and 4 new types of fomentation are contributions to panchakarma
- Different surgical instruments like catheters, trochars and canulas are described as näòéyantra
Commentaries on Astanga hridaya
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